Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1997 Oct 1;157(7):889–896.

Inappropriate hospital use by patients receiving care for medical conditions: targeting utilization review

C DeCoster 1, N P Roos 1, K C Carrière 1, S Peterson 1
PMCID: PMC1228213  PMID: 9327796

Abstract

OBJECTIVE: To describe characteristics associated with inappropriate hospital use by patients in Manitoba in order to help target concurrent utilization review. Utilization review was developed to reduce inappropriate hospital use but can be a very resource-intensive process. DESIGN: Retrospective chart review of a sample of adult patients who received care for medical conditions in a sample of Manitoba hospitals during the fiscal year 1993-94; assessment of patients at admission and for each day of stay with the use of a standardized set of objective, nondiagnosis-based criteria (InterQual). PATIENTS: A total of 3904 patients receiving care at 26 hospitals. OUTCOME MEASURES: Acute (appropriate) and nonacute (inappropriate) admissions and days of stay for adult patients receiving care for medical conditions. RESULTS: After 1 week, 53.2% of patients assessed as needing acute care at admission no longer required acute care. Patients 75 years of age or older consumed more than 50% of the days of stay, and 74.8% of these days of stay were inappropriate. Four diagnostic categories accounted for almost 60% of admissions and days, and more than 50% of those days of stay were inappropriate. Patients admitted through the emergency department were more likely to require acute care (60.9%) than others (41.7%). Patients who were Treaty Indians had a higher proportion of days of stay requiring acute care than others (45.9% v. 32.8%). Patients' income and day of the week on admission (weekday v. weekend) were not predictive factors of inappropriate use. CONCLUSION: Rather than conducting a utilization review for every patient, hospitals might garner more information by targeting patients receiving care for medical conditions with stays longer than 1 week, patients with nervous system, circulatory, respiratory or digestive diagnoses, elderly patients and patients not admitted through the emergency department.

Full Text

The Full Text of this article is available as a PDF (147.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen R., Chen M. S., Aday L. A., Cornelius L. Health status and medical care utilization. Health Aff (Millwood) 1987 Spring;6(1):136–156. doi: 10.1377/hlthaff.6.1.136. [DOI] [PubMed] [Google Scholar]
  2. Billings J., Zeitel L., Lukomnik J., Carey T. S., Blank A. E., Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) 1993 Spring;12(1):162–173. doi: 10.1377/hlthaff.12.1.162. [DOI] [PubMed] [Google Scholar]
  3. Inglis A. L., Coast J., Gray S. F., Peters T. J., Frankel S. J. Appropriateness of hospital utilization. The validity and reliability of the Intensity-Severity-Discharge Review System in a United Kingdom acute hospital setting. Med Care. 1995 Sep;33(9):952–957. [PubMed] [Google Scholar]
  4. Ludke R. L., MacDowell N. M., Booth B. M., Hunter S. A. Appropriateness of admissions and discharges among readmitted patients. Health Serv Res. 1990 Aug;25(3):501–525. [PMC free article] [PubMed] [Google Scholar]
  5. Marmot M. G., McDowall M. E. Mortality decline and widening social inequalities. Lancet. 1986 Aug 2;2(8501):274–276. doi: 10.1016/s0140-6736(86)92085-4. [DOI] [PubMed] [Google Scholar]
  6. Marmot M. G., Rose G., Shipley M., Hamilton P. J. Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health. 1978 Dec;32(4):244–249. doi: 10.1136/jech.32.4.244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Payne S. M. Identifying and managing inappropriate hospital utilization: a policy synthesis. Health Serv Res. 1987 Dec;22(5):709–769. [PMC free article] [PubMed] [Google Scholar]
  8. Roos L. L., Jr, Roos N. P., Cageorge S. M., Nicol J. P. How good are the data? Reliability of one health care data bank. Med Care. 1982 Mar;20(3):266–276. doi: 10.1097/00005650-198203000-00003. [DOI] [PubMed] [Google Scholar]
  9. Roos L. L., Mustard C. A., Nicol J. P., McLerran D. F., Malenka D. J., Young T. K., Cohen M. M. Registries and administrative data: organization and accuracy. Med Care. 1993 Mar;31(3):201–212. doi: 10.1097/00005650-199303000-00002. [DOI] [PubMed] [Google Scholar]
  10. Roos L. L., Sharp S. M., Wajda A. Assessing data quality: a computerized approach. Soc Sci Med. 1989;28(2):175–182. doi: 10.1016/0277-9536(89)90145-7. [DOI] [PubMed] [Google Scholar]
  11. Smith C. B., Goldman R. L., Martin D. C., Williamson J., Weir C., Beauchamp C., Ashcraft M. Overutilization of acute-care beds in Veterans Affairs hospitals. Med Care. 1996 Jan;34(1):85–96. doi: 10.1097/00005650-199601000-00007. [DOI] [PubMed] [Google Scholar]
  12. Strumwasser I., Paranjpe N. V., Ronis D. L., Share D., Sell L. J. Reliability and validity of utilization review criteria. Appropriateness Evaluation Protocol, Standardized Medreview Instrument, and Intensity-Severity-Discharge criteria. Med Care. 1990 Feb;28(2):95–111. doi: 10.1097/00005650-199002000-00001. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES